Allina Health - Edina Clinic Primary Care Clinic

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1 Allina Health - Edina Clinic Primary Care Clinic Facility Background/ Data Year established/historical background Ownership/type/focus Location Geographic region, urban/rural Metro area population Leadership structure/composition In 1993 HealthSpan and Medica merged to form Allina Health System, a not-for-profit integrated health care system committed to enhancing the health status of the communities it serves. In July 2001, Allina Health System was restructured into two, independent, non-profit entities: Medica, a health plan organization, and Allina Hospitals & Clinics, a healthcare delivery organization. Allina Hospitals and Clinics subsequently changed its name to Allina Health to reflect a new mission that shifts the emphasis away from places that people go when they are sick and onto disease prevention and personal vitality. Allina Health is a not-for-profit integrated health care system based in Minneapolis, Minnesota. The Allina Health Edina Clinic is an ambulatory primary care and specialty clinic. Allina Health owns or operates 14 hospitals and more than 90 clinics throughout Minnesota and western Wisconsin. The clinic is located in Edina, MN (population 47,941), a suburb immediately southwest of Minneapolis, MN (Metro area population 3,524,583). Allina Health is led by President & Chief Executive Officer Penny Wheeler, MD.

2 Implementati on of chiropractic services Size Beds/catchment/enrollees Departments/employees Revenue sources (private, Medicare, Medicaid) Notable current initiatives/changes CAM, spine, pain/opiate Patient experience Impetus/climate/background Planning process/timeline The lead physician for the Edina Clinic is Scott Flaata, DO. Allina Health s 2015 annual net operating revenue was $3.8 billion. The system includes1,789 staffed beds, 27,332 employees, and 6,000 associated and employed physicians. The Allina Health Edina Clinic is a 23 room facility providing primary care and select specialty services including chiropractic care, diabetes care and education, anticoagulation/inr clinic, mental health, podiatry, and rheumatology. The clinic accepts a mixture of cases including private insurance, Medicare, Medicaid, and self-payment. The facility offers acupuncture, massage therapy, nutritional consultations, aroma therapy, wellness coaching, and healing touch. Establishing a chiropractic clinic was initially conceived more than 20 years ago by the District Medical Director. Although at that time only about only about 1/3 of the physicians approved of the idea, the District Medical Director was an innovator and a strong advocate for adding chiropractic services. The Lead DC was introduced, by a friend, to the District Medical Director who was looking at adding an additional physician to the clinic. The planning process was more educational, helping colleagues understand the DC s scope of practice. The lead DC s former clinic manager was hired by Allina It was the idea of the medical director for this region, that he was really open to alternatives for his patients and got tired of writing scripts all the time, for patients, especially with back pain and neck pain. And so he sought out looking for a chiropractor, how might this blend with a primary care setting? (Provider) Eventually we hired ten chiropractors within the system and I actually helped train all those sites, all the physicians, all the meetings, to get all those sites established and set up. So it really is just a lot of leg work, a lot of communication, and I think that s probably the key, is the communication." (Staff)

3 and provided guidance. Mainly, it was a learn and grow process. Over years of time, planning process has grown clinic to include several multidisciplinary providers including internal medicine, psychology, chiropractic with acupuncture, and a dietician. It s a nice clinic to practice in terms of location-wise and great colleagues and the fact that we are not just internal medicine here, but we have other things like psychology, chiropractors, we have a dietician. So, that s just like a multidisciplinary approach, which I think is great, yes. (Provider) Year clinical services established In 1996 the current lead chiropractor was offered a position at Allina Health to start integrating chiropractic services at the Edina location. Chiropractic Clinic Structures Administration Department/service line Performance measures/benchmarks Location/space/equipment Chiropractors Number/FTE/appointment Privileges/services Non-clinical activities Professional attributes Interprofessional attributes The lead DC oversees chiropractic clinic activities. The clinic chiropractors are assessed on a model including productivity and patient satisfaction. The chiropractic clinic includes four examination/treatment rooms furnished with state of the art tables and other necessary clinical equipment. The facility uses the EPIC electronic medical record system, with the MyChart patient portal. The chiropractic clinic is staffed by 3 DCs (2.3 FTE). There are 2 other DCs at additional locations in the Allina Health system. Chiropractor privileges are consistent with training and state licensure. DCs participate in non-clinical activities including grand rounds presentations and All of our providers have work RVUs, so they have a budget and are expected to maintain or exceed their budget work RVU. So that s one measure. But then we read patient comments, we do CG CAHPS, patient surveys, and the patient comments are just extremely high for all three of the chiropractors. They all score really highly on patient experience, on provider communication, so I think that they re doing a great job.(staff)

4 Support staff Discipline/number Patient access Referral, self-referral Appointment availability/wait Appointment length, number per week service on hospital quality assurance and other committees. One full-time and one floating certified medical assistant (CMA) provide clinical support to the facility chiropractors. Patients may self-refer or be referred from other providers, most often primary care, sports medicine/orthopedics, and the Penny George Institute for Health and Healing. The chiropractic clinic is open Monday through Friday for about 48 hours per week. It could be that a patient may have to wait two weeks to be seen, but that s rare, because our chiropractors want to see people as soon as possible, so they re staying late, they re working over their lunch hours, they are double booking just to get these patients in. (Staff) Chiropractic Clinic Processes Relevant partnerships Academic, research Patient characteristics Population, conditions, complexity Access patterns seen New patient visits are scheduled for 45 minutes, and follow-up visits for 15 minutes. On average the clinic sees 18 new patients and 215 follow-up visits per week. Allina Health is home to the Penny George Institute for Health and Healing, a major integrative medicine effort founded through philanthropic support. As of Spring 2017 the Institute will include its first Allina Health chiropractor. The majority of patients are adults seen for musculoskeletal pain conditions of the neck and/or lower back. Patients with headaches and extremity musculoskeletal conditions are also common. A typical patient is a female office worker. Clinic chiropractors routinely provide expedited access for acute cases. My initial expectations were usually more musculoskeletal-based chronic back pain and neck pain here in [the Edina Clinic] they focused a lot more on acute care type of chiropractic care and so for that reason I was able to use it more in the sense of acute injuries. (Provider) Given the relationship that I have with our chiropractor group, they understand if I have a patient with a more acute need that they will work them into their schedule. And it works both ways. If they have someone that

5 Impacts/Outc omes Services provided Diagnostic, therapeutic Case management CPGs/care pathways used Outcome assessment/reporting Communication/collaboration with other providers Clinic function Use, utilization, performance benchmarks Patient status Outcomes, satisfaction The chiropractic clinic provides full scope diagnosis and management of musculoskeletal conditions. The most common treatment options are manipulation and mobilization techniques, manual myofascial therapies, acupuncture, and physical modalities. Active approaches include patient education, therapeutic exercise, and nutritional and lifestyle recommendations. Treatment plans are individualized based on patient factors. An initial treatment trial ranging from 1-6 visits is used to assess patient response and determine next steps. Clinical outcomes are assessed using a number of validated instruments to measure pain intensity, disease-specific pain interference, and functional ability. Interprofessional communication occurs readily and is facilitated by the physical colocation of clinicians and the functionality of the EMR. Allina Health uses the Agency for Healthcare Research and Quality s Clinician & Group Survey, Consumer Assessment of Healthcare Providers and Systems (CG- CAHPS ) to survey patients about their perceptions of care received. The chiropractic clinic has been among the Allina Health Edna Clinic s top performers on this measure. Patients expressed high satisfaction with the quality of care they received from the facility s chiropractors. Patients also appreciate the collaborative approach by they want me to see more urgently, I ll do the same thing. (Provider) I 100% can tell you [patients are] very happy. I have not had any patient make a complaint to me about the chiropractic care. And for many of them it s a real

6 System status Facility actual (or impression of) value Non-DC staff impression DC staff impression which chiropractic services are integrated with the overall clinical team. The chiropractic clinic appears to be highly valued by facility leadership and referring physicians. Staff reported very favorable perceptions of both the quality of patient care, and the collaborative nature of the chiropractors. Allina Health DCs serve on various hospital committees including the Concussion Work Group, Sports Medicine Advisory Council, Medical Spine Program, Medical Advisory Council and Twin Cities Spine Center Grand Rounds. The relatively low insurance reimbursement rates for chiropractic services limit the chiropractic clinic s impact on the facility s overall fiscal bottom line. convenience to be in the same building as their Primary. (Provider) Even after that initial time period that I had first seen [the chiropractor], everything was better. Like the pain, I don t have the shooting pains up and down my back any more, up and down my spine, which is a huge improvement, in and of itself. (Patient) I don t think I could provide as good care with solid outcomes without having chiropractic available for my patients. (Provider) I think there s great value and I think the access people have to be able to get in quickly and get their acute [pain] concerns addressed right away is really key. (Provider) Part of what s allowed there to be success is that we can all come to the common ground that it s not about me or what I do it s all about getting that patient to the right place at the right time for the right care. (Provider) Notes: Population data from 2010 US Census Bureau estimate

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